Friday, February 23, 2007

Why Docs Don't Like Xanax (some of us)

[BTW, you might also be interested in checking out our related podcast, #19: Xanax Blues.]
This is in response to JW's question below about the "rules" docs use about prescribing Xanax/alprazolam. Not all docs feel this way, but here's how I think about it. Of course, I am not suggesting that, if you are taking this anti-anxiety drug, you should stop it. I'M NOT. Talk to your doctor if you have concerns.

The half-life for Xanax is short... on the order of 6-20 hours. Halcion is the only similar sedative that has a shorter half-life (and that one has even more problems). Thus, it doesn't stick around long. It is also quite lipophilic, meaning that it quickly gets into the brain. So, it has a quick on, quick off way of working. Sounds great, right?

The quicker a drug works, especially one which makes you feel good in some way, the more addicting it is, as the cause (taking it) and effect (feeling it) are close in time, making it very reinforcing. This is fine if you just take it on those rare anxious moments where you need something to get through it. However, since it works so quickly, many folks start taking it more and more often, until it gets to the point that they are taking it daily. Then they start taking it as soon as they feel it wear off. Before you know it, you are taking it 3-4 times per day. Now, that's not the big problem.

The big problem is all because of your brain's laziness. See, your brain makes it's own natural Xanax-like substance, called GABA. GABA works by inhibiting the brain's natural tendency to speed up. It's like a brake pedal, where the accelerator is stuck in the pedal-to-the-metal mode. GABA keeps your brain from over-working. Xanax (and other sedatives, and alcohol) works by acting like GABA in the brain (sort of). If you start taking it daily, your brain starts thinking "I guess I don't need to make so much GABA because this Xanax stuff is here, so I'll only make 20% of what I usually make." It takes a week or more for your brain to stop making the GABA (which is why just a few days on Xanax won't lead to much trouble), and a week or more for it to start making it again when you stop taking the Xanax.

Here's where the trouble begins. If Xanax wears off in just a few hours, but it takes a week for your brain's natural Xanax to kick back in, what happens in the interim? Withdrawal. What does that feel like? It feels like a panic attack, but worse. High blood pressure, rapid heart beat, tremors, confusion, delirium, hallucinations, seizures. What do folks do when they feel a panic attack coming on? Take another Xanax.

As a hospital-based physician, I see lots of folks, often older, who wind up with severe withdrawal problems from Xanax. It's usually because they run out of the drug, decide to cut back or stop taking it, or something else happens (eg, stroke, get sick) and they forget to take it. Or they don't tell their surgeon they are on it, and 2 days after their hip surgery I get called because they are hallucinating.

Some prescribers think it is a good antidepressant (it's not). Or that, because of the short half-life, it's not as addictive (it is).

So, here are my rules of thumb about Xanax:

  1. Avoid it.
  2. Keep the doses small.
  3. Do not use in older folks or forgetful folks (more likely to forget it, thus more likely to have problems).
  4. Do not use in anyone with a history of alcoholism or addiction (yes, that means you have to ask).
  5. Tell folks to avoid from daily use.
  6. If they are on it, warn them that stopping it suddenly, even for a day or two, can result in confusion, hallucinations, seizures, and even death.


ania said...

This was an excellent example of clear "technology of pharmacology" writing for non-technical readers.

Good job.

Midwife with a Knife said...

Sorry, not really related. Just a message for dinah.

Dinah: Thanks (re: the quiet night). It's a total of 60 minutes for psych, domestic violence, substance abuse, and trauma. The trauma bit can be short, probably less than 20 minutes. I know that it's kind of an impossible task. I could talk about pp depression alone for 60 minutes (or more?).

It's fine if you'd like to do it as a blog post and feel free to refer to me. :) I'll probably copy this to you're blog, also, to make sure that you see it.

Midwife with a Knife said...

Just out of curiosity, what is xanax good for, other than being a nice palindrome, which is clearly important for drugs.

I've never ever prescribed it. I've written for ativan on occaision, but never xanax. Even when people come into the hospital on xanax, I still write for ativan instead. Mostly I try to avoid writing for benzos outside of alcohol withdrawl. I feel like if someone has so much anxiety that they need a benzo, they probably need a psychiatrist or family doctor or someone who is smarter than I am managing it.

Sarebear said...

I will start this comment by saying I am not taking anything you said as medical advice; I know it is not, it is your opinions, your perspective from your experiences that you made a BLOG POST on, and not medical advice to anyone. I know this.

With that said, My thought on your list at the bottom was Hey, that's much more than my iatrist told me, but it was a sub at the time since he was suspended, anyway.

MY experience with Xanax, has been this: (and is not intended as advice for anyone!)

I used it sparingly, a quarter to half a pill, once to three times a week ROUGHLY, the first month or two after I was prescribed it; Most often once a week, with often twice, and rarely three times. As needed, when experiencing anxiety that felt it was leading to or would lead to a panic attack; I took the Xanax to shut down this cycle. And it worked (for me).

After two weeks of this, the needed instances reduced in frequency; I marveled at that, but the sub iatrist had told me that when used properly, it can have the effect of reducing the frequency of the anxiety/panic cycles . . . I really felt that, as I had kept shutting down the panic before it could get a foothold, that it then, after a couple of weeks of judicious use of small, small doses of the medicine, that the panic cycles had been disrupted, as she had said might happen, and so I found that to be true, for me.

I did, though, have alot of trouble identifying anxiety and it ramping up, as it is so much a part of me, that separating it out as a problem, as instances of it being a problem, was difficult for me.

And that led to me not using the Xanax very often at all . . . it trailed off to once or twice a month, and then not any for months in a row, and now it's probably been half a year or more.

I discussed this with my iatrist (again, this is my personal experience, and not advice to anyone), and we talked about how many people overuse the drug, but then I summed up the above and how I thought I was maybe under-using it, ie, the effect it had had, of slowing down the frequency of the panicking, when used to shut down such panic events consistently and judiciously for a period of time, that that would be really good for me, that it felt really beneficial, that it FELT like with that, in combo with the other meds and therapy, that I had felt a clarity of SELF, of THINKING, when having the anxiety managed better, than I do with it running rampant.

I had and still do marvel at the ways in which meds can sometimes take away layers of various illnesses, and reveal to me that there are levels of mental functioning that feel so RIGHT . . .and so, well, NORMAL, in contrast to how I've been my whole life, NORMAL in a way that I marveled at and hadn't felt . . . first, when the Neurontin ramped up and seemed to take away a bipolar or some illness-induced fog in my brain and self-hood that had clouded so much of my potential from myself . . . .

And, of course, therapy was a big factor in the mix as well.

Then, last August, adding exercise, even just tiny bits in, seemed to have as much impact, although in a different way, as the med had, or the therapy had . . . ie, it felt like a real triple combo of effectiveness, adding exercise (which helped clarity of mind and beingness, among other things) to the therapy and meds . . .

Anyway, I guess I've gone from specifically the xanax to the benefit of different things in combination that I've found of benefit to me (personal experience, woops I'm over-caveat-ing, lol).

So, long though this comment may be, I think it is pertinent. Good post. I think for many of the reasons you explain, I have been and am wary of Xanax, which is good, but I think (and discussed with my iatrist to this conclusion, for myself) that I need to not be SO afraid of it that I don't utilize it judiciously for improvement in my health and situation.


Sara (verify was xnxgol) xanax gol? hee hee

Patient Anonymous said...

MWAK: I'm not a doctor however Xanax is generally used for GAD, Panic Disorder, possibly off label for OCD? It would depend on the prescribing pysician?

It has no anticonvulsant properties so is not used for seizure control/prophylaxis. Some benzodiazepines are.

But indeed, it does have the shortest half life so titration (increase) may become problematic. There is an XR (extended release) formulation also available.

I've always likened benzos to a good pair of shoes. You have to find the "right fit." Although I haven't been on Xanax I have been on others and some have worked, some haven't. It's that way with a lot of meds in the psych pharmacopoeia.

I've never had a "problem" with the one that was the right fit (for anxiety and sleep) for me and have taken it for various periods of duration, gone on/off as needed.

Recently it was traded in for a hypnotic, however.

I am currently taking one benzo now
(Clobazam--not available in the US) for seizure prophylaxis--no anxiolytic relief or sleep benefits from that though.

Midwife with a Knife said...

PA: I'm familiar with the common indications for prescribing benzos. Maybe I didn't ask my question clearly. It's just that most doctors that I know don't like using xanax, so I wonder in what situations it has advantages over other benzos like ativan.

Dinah said...

MWAK: None.
I've never prescribed Xanax as a new prescription started by me. Ever.

Sarebear: Your example of intermittant then dwindling use of xanax is fine. The issue is that some people get addicted, not everyone. If we knew who would or wouldn't at the outset, I'd prescribe Xanax. And exercise is a wonderful way to deal with a whole host of emotions, I "prescribe" it often. I even do it a few times a week, but I'm no 9 minute miler the way Clink is.

Roy: Is something wrong with our gmail address? I'm not getting notice of our posts and I never got repeated emails from MWAK-- this is just since today.

Roy & Clink: I've been telling you that you have grown to sound alike. Previously, I've hit the word "penitentiary" before realizing it was Clink, not Roy. Today, on this post, I thought Clink was writing, then got jarred by the "I'm a hospital-based..." and realized it was Roy. If you start to look alike, I'm outta here.

sophizo said...

What about XR? Do you feel the same way about the extended release version? Just curious.

Unknown said...

Sounds like good advice and a clear explanation.

I typed xanax 'cause I have trouble typing and didn't want to waste letters typing benzodiazepines!

I have taken xanax in the past, a decade ago or so. I have a genetic tremor: Anxiety, too hot, too cold, too tired, too ... Many things can make the tremor much worse.

There's only so much propranalol can do and I can't take too much or my heart rate goes too low. Xanax would be a good fit as a back up drug for when needed. Many of the other benzos have no effect ... others last too long.

Anonymous said...

Great article. I'm not a fan of prescribing alprazolam, either. And I dislike using the XR/CR version. Besides, I've been using the extended release version for years; it's called Ativan. OK, it's not a good for panic, so that's why I use the XL version, called Klonopin.

Steve & Barb said...

Ania- Thanks for the kudos.

MWWK- It's good for the exact situation Sara mentions (well-written Sarebear). Is Ativan any better or worse. Probably not, though is somewhat less lipophilic, so it takes longer for a given oral dose to start working.

Carrie- Sounds like the worst atypical panic attack I've heard of.

PA- I use your shoes analogy a lot.

Dinah- I don't think Clink and I write alike. I think most in free society would agree.

ClinkShrink said...

I don't think Roy and I write alike either. He write eruditious and me don't.

Anonymous said...

Here's my Xanax story -

6 years ago, a psychiatrist treated me for depression. In his words, he said, "I'm putting you on Prozac and Wellbutrin; they'll speed you up, so I'll put you on Xanax to bring you down." When I expressed my concern, he assured me that Xanax was not addictive, and that he was putting me on a non-additive dose.

Neither he nor the pharmacist told me that Prozac raises the level of Xanax in a person's bloodstream by fourfold. So, I was getting a wallop of it. All the pharmacist said to me was "Does your doctor really want you to take all these drugs together?" I said yes; she made no mention of the interactions. Neither did she say that my name would be put on a state registry of Xanax users, because it is also a street drug.

After a couple of days, I got hooked on the drug, even though I never took more than the prescribed dose (didn't matter anyway, Prozac made certain of that). I couldn't sleep without taking the Xanax. This all went on for a year, until I finally bit the bullet and stopped cold turkey.

I didn't sleep for an entire week, which was the worse problem I had. But I got off the stuff, and hopefully off the state registry not long after.

I didn't realize at the time that this doctor was a polypharmacy whore, who couldn't be bothered with aquainting himself with the drug interactions of what he was prescribing. Since that episode, I don't get a prescription filled unless I check out the interactions, which is easy to do now that has an interaction checker. No more trusting doctors or pharmacists with this little task.

I'm sure that others have found Xanax to be an effective drug and that it doesn't cause them any problems. I'm not saying that others shouldn't take it. However, I do feel strongly that any doctor or pharmacist should be honest about Xanax's additive tendencies and withdrawal problems, that it is a street drug and a controlled substance, and that a person may find themselves on a state registry of users once they fill a prescription.

Sorry for the rant, but I have strong feelings about this drug.

a psychiatrist who learned from veterans said...

All benzodiazepines help conflict avoidance however patients tend to prefer Xanax for that. A choice that is not completely positive because Xanax is also promanic as well as being antidepressant. One reference says don't use it in more than, a divided, 2 mg a day (if I knew how to do 'indexing' searching on my computer I could give it to you) that is, in general to avoid tempting people to abuse it though I do think the XR is safer in that regard.

Ruth said...

Found my way to this post via Furious Seasons, who commented that while he understood why shrinks don't like Xanax, but queried why they were so much more comfortable doling out anti-psychotics of questionable efficacy on a long-term basis, given the side-effects.

To that I'd add the SSRIs. While they don't give you that nice initial buzz that Xanax does, there's no doubt in my mind that they are physically, if not psychologically, addictive. After going off Aropax/Paxil cold-turkey as a teenager... I went back on it, as projectile vomiting and falling over every time I tried to stand up wasn't much fun. My shrink at the time ridiculed my assertion that these were withdrawal symptoms, claiming that SSRIs could be stopped immediately, any time.

I realise that only a truly incompetent shrink would say a thing like that nowadays, but I still believe that the 'long-term commitment' (for want a of a better phrase) required to embark on a course of SSRIs is understated by doctors. Basically, if you're going to take them, you might find it very hard to stop, particularly if a change in circumstances present a compelling reason for you to do so (e.g. pregnancy).

Sarebear said...

Thanks, Roy.

I did write it partly as a response to MMWK's question, and partly of course to show my experience with it, when used carefully, as a contrast to the main post.

Sometimes my old writing ability comes through; I wish it'd visit more often . . .

Anonymous said...

Wow, that description was perfect for my own experience. My mom had trouble with tintinnus (ringing in the ear). She is also prone to panic attacks, depression, etc. After moving to my area of the country after the death of my father, she soon found herself without her Xanax. I found a physician for her and he wrote her a new script.

She was supposed to take it three times a day(!) When I had an occasion to check on her meds, I found she was taking it 6 to 10 times a day instead. She was caught in a spiral.

Long/short, I got her off Xanax. After withdrawal, she is finally normal again. Funny thing, no more ringing in the ears...

Anonymous said...

Ruth, I'm probably quibbling over semantics here, but I don't see SSRI's or antipsychotics (with the exception of maybe seroquel) as being addictive. I think of it more as tolerance rather than addiction. The drugs do cause withdrawals once they're taken away, but that's different than addiction. I took both SSRIs and SNRIs in high doses for years. I went through horrible withdrawals (or as the drug companies put it - discontinuation syndrome) when I stopped taking them. Like you I did have to put myself back on them and slowly taper off, but the psychological desire/need wasn't there - ever. I have been off them for over 4 years and there's no temptation to take them again. I don't think that would be the case if I were addicted. Also, if they were psychologically addictive it wouldn't be so difficult for psychiatrists to keep patients on the meds. Just my opinion for whatever it's worth...

~~Noncompliant in Texas

Mother Jones RN said...

I've taken care of patients who are hooked on "mother's little helpers," and many of them don't want to give Xanax up. Withdrawl from Xanax is a very hard thing to watch. I once saw a woman pull her hair out of her head when she was getting off of this stuff.


Anonymous said...

Thank you for a great, very informative post.

More, please!

Ruth said...

~Noncompliant in Texas @ February 26, 2007

I'm using the Collins Dictionary of Medicine definition of addiction: a condition where "the use of a drug has led to persistent changes in the way the body functions so that its absence causes physical symptoms - withdrawal symptoms".

So, I do consider SSRIs as physically addictive, although generally not psychologically addictive - with the caveat that, during the final, most difficult stages of withdrawal, people clearly can develop strong psychological needs/cravings - as exemplified by the practice of shaving tiny fragments off the pills in an effort to continue cutting down. I also suspect that compliance issues are much more common with respect to anti-psychotic medications, on whose addictive potential I did not comment.

Steve & Barb said...

The problem here is with this Collins Dictionary definition of addiction. This is an awful definition, as it is over inclusive.

By this definition, other "addictive" drugs -- which cause physical symptoms on disconinuation -- would include:
-seizure meds, like Dilantin
-some blood pressure meds, which may result in rebound hypertension
-Sinemet, for Parkinsons
-nitroglycerin and other nitrates

Stedman's Medical Dictionary defines it as "Habitual psychological and physiological dependence on a substance or practice beyond one's voluntary control.." The key missing components in Collin's are "habitual" and "voluntary control".

Kim said...

Oh, are you SO right.

In the early '90s I was going through a horrendous period of stress and family issues. I was put on xanax 0.5mg qid - or 2 mg per day.

What happened was that instead of taking xanax for the anxiety, I noticed anxiety if I didn't' take the xanax - and as things in my life were smoothing out, the should have been LESS reason to take it.

So, I thought "I don't need this anymore" and I threw the bottle down the sink.

You wanna talk "withdrawl"? I don't have panic attacks. I had one for two days. I jumped at the least sound for a week.

Now, I knew what was happening to me so I called my doc and said, "Just reassure me that I'll be okay and I'll ride this out." He did and I was within a week.

But oh my god, never, EVER stop a benzodiazepine cold turkey like that. I'm a nurse, I should know better. But when I realized the tables had turned and that I was anxious WITHOUT the drug instead of taking it BECAUSE I was anxious I wanted that medication as far away from me as possible.

So I guess you can say I have actually had withdrawl symptoms from a physical addiction, albeit mild.

Not fun!

Anonymous said...

I was prescribed Xanax just once, by a well meaning but naive health care provider.

The only reason I didnt get into trouble was by knowing that there's a heavy history of ETOH addiction in my family. I sensed I could easily get hooked on the stuff and used it sparingly.

What helped my insomnia/anxiety much more has been

1) Minimizing caffiene intake

2) regular aerobic exercise (as measured using a heart rate monitor)

3) consultation with a doctor of chinese medicine who prescribed a combination of herbs and acupuncture that assisted with stress and have been non addictive. I only get needled once a month. The herbs support
immune function.

There is at least one acupuncture protocol that probably triggers GABA as powerfully as any oral medication.

My practitioner told me she takes care never to knowingly use it in anyone for whom it might suppress awareness of things they need to change long term in thier lives.

Yoga, certain meditation procedures and acupuncture are valuable, but some of this is can have such powerful transquilizing properties that they can be abused addictively, exactly the way Xanax and ETOH can.

Janie said...

Excellent explanation.

As a psychiatric nurse practitioner, a never start a patient on xanax either. I will continue their existing prescription, but warn them about the risks. The addictive part is problematic, and often when I try to get them off the xanax by switching to a longer acting benzodiazepine (preferably clonazepam), it's often a struggle.

I'm very pleased to have discovered your blog in a medscape article, and congrats on celebrating 1 year of blogging.

Roy said...

Good points, Anon.
Janie, glad to have you stop by. Thank you for the kind words.

Denni said...

I have an ancient prescription of Xanax that has helped me in a pickle many a time. I had that packet for over a year and a half and there is still enough left to last.

I take Xanax (1/2 to 1 pill) to stop a panic attack, i.e, strictly as an emergency measure, when symptoms are already occuring. My panic attacks are debilitating and occur in bouts, with 3 days of intense recurrent attacks (that can run into each other and go on for hours) followed by a few more days of increased anxiety. After that, I'm fine again. But during that period, I need effective treatment.

I use Xanax because it acts fast, and I'm very careful with it because I dread the possibility that I should ever develop tolerance and it loses efficacy as a result.

It took me a long time to find a doctor (a GP) who is sympathetic to my requirements.

Why is it so hard for shrinks to understand that patients are able to understand that certain meds are addictive and are able to manage them accordingly? Why is it so rare for a shrink to work with the patient instead of being judgemental towards them?

Anonymous said...

Funny, we're still getting comments on this post, and comments about this post on other posts (if that made sense).
Really, even those of us who do not like xanax don't like it on a chronic basis, it's really a whole different thing on an as-needed acute basis and I don't know anyone who would object to periodic use for panic disorder, or anxiety related to flying, or whatever. This post was really addressing the problems with chronic use, and Roy did put up his thoughts on how it's appropriate to use it. The post, as I read it, was about the pharmacology of why xanax is a medicine prone to decreased efficacy with daily use and lots of symptoms with cessation. I don't believe I saw anything about judging the patient, just about why the medication causes some people problems. Clearly, not everyone who takes a xanax tablet escalates the dose, becomes dependent on it, drug seeking or addicted, and the medicine has some really beneficial effects (ativan and valium do, too, with slightly longer half-lives).

Anonymous said...

What if a doctor were to prescribe Xanax for over 4 years without supervision?
That’s what happened to me.

I was given Xanax for severe anxiety/panic attacks and it was highly effective. Sure, I was a little bit foggy at times and of course I had to increase the dosage as time wore on, but it worked wonderfully.

Then, I got a new primary care doctor who seemed rather horrified by my story even though I was perfectly happy. In fact, I asked “What’s the problem?” based on her reaction and temporary blank stare of disbelief that another physician would prescribe Xanax for that amount of time, never have a follow up appointment or phone call yet continue to refill and by voice mail for that matter. So, she assumed I was addicted and said I was coming off it. We didn’t really discuss how I felt about it. She just decided.

I guess I have formally been "off" of them since about March although if I can get some from friends etc, I definitely take them as it is rare relief from this anxiety hell that promptly returned when my supply decreased and ultimately ran out.

Before I continue, let me say that based on the day, my feelings towards my current primary doctor vacillate between great appreciation and extreme resentment. For the last few weeks, I have been in “extreme resentment” land. If you gave me an ink blot test, every image would get the same response of, “It looks like the woman who took away my Xanax causing me to have to sit here and look at ink blots.”

That said, I guess my comment really is also a question in that, who is a doctor just to arbitrarily decide that a course of treatment that was approaching half a decade and that was successful to that point despite the "addiction" was no longer viable? I realize how that sounds but in most medical situations these days, doctors want YOU the patient to decide ala "Here are your options." Yet, when it comes to Xanax, I feel like I've entered a realm of wimps--a bunch of benzophobes who can not POSSIBLY understand what effect on the mental health and quality of life their fears are having on their patient. Where does the do no harm enter if a new doctor inherits this situation and by taking a patient off of Xanax, the patient is “harmed” through continued withdrawal symptoms, unbearable anxiety (constant thoughts that people you love are going to die, can’t function normally in public or use public transportation, scratching arms to the point they bleed due to nerves etc..) and so forth? Isn’t it MORE harmful to take it away from them?

It seems very unfair that the patient has to suffer because the doctor doesn't like the drug.

If I am an educated (I’m post-grad), informed consumer fully aware of the negatives and positives of a drug, and it is a legal drug, why then should an MD ruin, or at the very least cause a massive problem in my life by taking the option that works for me away? I completely understand the risk-benefit situation and accept it so why do I as the patient have no say? Do doctors just feel, as mine said, an ethical obligation to make decisions when they feel a patient is speaking from an addiction? Do doctors really believe this or is it a fear of something else? What? Could a patient in my situation for example formally complain about the first doctor so the second doctor HAD to take action?

Can someone PLEASE for the love of God explain this to me??? WHAT is the problem???????

And yes, my new doctor and the psych she sent me to tried everything under the sun as an alternative but, compared to Xanax, they are simply unacceptable. Even my doctor admits that nothing works as quickly or as effectively as Xanax although she also added that this quality is precisely what creates situations like my own. But again, if I am choosing to accept the consequences that go along with the benefits of Xanax, why does a doctor think they have the right to deny me that?

Anonymous said...

"Do doctors just feel, as mine said, an ethical obligation to make decisions when they feel a patient is speaking from an addiction?"

Absolutely. And no doctor has an obligation to support a suspected addiction. When I hear 'nothing works except Xanax' paired with dismissal of any other alternatives, I know I'm talking to an addict. When I read an admission that 'of course I had to increase the dosage as time wore on', I know I'm talking to someone who's developed physiological tolerance with dose escalation. In short, the doctor you're angry at did the right thing.

Anonymous said...

I'm not necessarily angry with her in that I do, to some degree, understand her stated position which was that as my physician she can not continue to prescribe a drug she has determined me to be "addicted" to. I get it.

However, can someone tell me where I am supposed to go from here? Any advice would be appreciated and if it is "Find a psychiatrist" or what have you, I have an inability to lie and so I ALWAYSSSSS disclose my prior use and my primary's belief that I had an addiction to Xanax and well, I'm sure you know where that gets me.

They all end up recommending the same thing--SSRIs. Is there any way to convince a psychiatrist while being honest about my history that I truly can manage the Xanax and that imo, it is what works for me? Or is this a hopeless cause? PLease be honest. If I were to present to some of you in here, is there any one who would let me try Xanax again?

Anonymous said...

from a patient...i am 39/f/ocd/GAD.
i have been on buspar,celexa,prozac,paxil,pamelor,lithium,luvox,zoloft,celebrex and just about anything else you can rattle off. none of them worked, they all made me fuzzy and fogged, and a couple of them made me wish to die.

i can understand from a d's point of view there are alot of xanax addicts out there. i know a couple. addiction is different from person to person, some ppl have a serious addiction gene whereas others have no additction gene at all. mine were marbrol lights by the way hardest thing i ever did was quit smoking..

anyway, what im trying to say is that if a patient such as myself, has taken xanax PRN over a few years and it works for the hardcore panic attacks,why wont a dr work their patient about xanax?no one knows theirselves better than YOURSELF unless youre a physco.i have used xanax as i said PRN for quite a long time, and it has changed my life. i dont see need in taking it if you arent having a panic attack,but its a blessing to have in the med chest when you are having a thrashing mental meltdown. i am on 3 mg a day,but i take PRN. im fine and i love life. xanax is a good thing if used properly,remember each patient is different!

Anonymous said...

Does anyone know if the generic brand of Xanax (Alprazolam) is equally effective as the name brand(?)
I started taking the generic alprazolam for about 6 years now. I have consistently stayed on the same dosage of 1mg per tablet, never raising the milligrams since I began 6 years ago. Back then I only took the pill about once or twice a month. However, in the last 3 years I have noticed that I take the pill at least every other day or so, usually no more than one pill. If I feel very anxious I will take 2 (2mg), but that only happens about once a month.
They suggest the pill be swallowed instead of chewed for maximum effectiveness; but in my case I generally don't like to swallow dry pills like Xanax, so many times I chew them, even though your not supposed to.
There are times when I "forget" to take xanax, so I assume on some level I can go without it. But to be honest, I think what has happened to me is that I have been using xanax more as a form of anti-depressant than I should, I don't know. I don't take any other psychiatric drugs. Is prozac and other such drugs a better choice? Less addicting than xanax? If anyone wants to commment on my thoughts, go ahead.

Eeyore said...

The worst part about Xanax has to be the problem of getting someone off of it after another shrink has made the mistake of starting it in the first place! I broach the subject only at the end of an initial encounter as a warning of what is to come, and even then only after a significant amount of work building rapport, and reassuring them that I am not an insensitive monster. Still, the response is predictable, and familiar to us all. Basically their eyes get big and teary, their skin blanches slightly paler, and they begin to beg for "my preciousssss" not to be taken away...The worst case Ive seen actually involved 25mg of librium TID and 0.5mg of xanax tid prn for "breakthrough". I wondered breakthrough what, consciousness?

Anonymous said...

I'd rather give my patients cannabis than any of this garbage the drug companies are pushing.

Anonymous said...

this is crazy. i have been so paranoid about this for about 6 months now. i was prescribed zanax at 1 mg a day(usually only take 0.5mg the little blue ones at night instead of full recommended dose) for thoracic outlet syndrome and its effects on relaxing chronic muscle cramps. well it has worked great but i am just the type of person that i am a multitasking fool and you better believe that i have forgotten to take it many of days and let me tell you what, my skin literally starts crawling. i have never had an anxiety attack and thank the lord still have'nt but i have come severly close on those days that i miss. it wasnt til recently that i started thinking OK, i cant jsut stay on this stuff forever and then started looking up various sites such as this one to see what getting off was all about. so far i'm pretty freaked out. i am ok with toughing out the anxiety and normal pain in the rear withdrawl symptoms i'm as mentally strong as anyone i know, having said that, what is all this i am reading about having seizures when coming off. so my question is this....
- do you think that 7-9 months of about 0.5mg a day and the occasional full 1mg tab will cause seizures if i just taper down to say 0.25mg twice a day for a couple weeks then eventually just one nightly dose of 0.25mg for a month or so i should be ok. i actually have not had ONE SINGLE negative side effect such as the memory impairment and vision disturbances..etc, this drug as been great for me but i cant read all this info and not get concerned and ignore my internal dialogue which by the way is screaming for me to just stop cold turkey. but again that whole seizure thing is scaring the tar out of me. any advice will help. thanks ahead of time.

Roy said...

Yeah, I can see why cannabis may appear to be safer than some prescription drugs (not sure about the efficacy, though).

Anyone wanting to know specifics about their own situation should always discuss it with their personal physician.

optic1 said...

I'm a clinician, primarily out-pt. I have been hooked on benzo's for approximately 8 years. I never did increase them for any buzz, I just was prescribed them for panic attacks. In my case early on I was able to stop cold turkey, and the effects were ok to handle as long as life was pretty good. The last few years I've had to slowly reduce them from 2 mg daily to .5 and this has been very hard to do. There is no particular prescriptive approach to/for anyone, we're simply all very different. It does make me sympatico with clients that are hooked as well which has me quite open minded with my client's other substance problems as well, or I at least try to understand. The new plasticity theory of brain change, especially with the rebound of anxiety and addiction probably is one of the worst , potentially long term addictions there is. It treats the symptom, but exacerbates it as it treats. And /or multiplies the sx as you withdraw potentially bringing back to square one cubed so to speak. However, I have nothing to complain about, ultimately, I have had zero panic attacks albeit with anxiety as I've tappered. This may speak to the medication's long term affect on the plasticity as well. Yin and yang and all that. My take on benzo's and prescribers is that they are too often the meds that keep clients coming back. This from my clinical perspective, yes and personal.

Anonymous said...

An interesting blog and hopefully those who read your opinions are able to discern what treatment is best in collaboration with their treating psychiatrist.

My background is that I have for all my adult life and most likley prior to that had depressive episodes with occasional hypomanic behaviours and anxiety disorders. I was first diagnosed in my late teens following a sucide attempt (of which there have been several over the years)and thus began for several years the use of various medications to treat both disorders (tricyclics, MAOs, many types of benzo's etc.) I ultimately stopped using and abusing all of them in the early 1980' (being young and stupid I discovered alcohol and cannabis) and they became my treatment of choice unaware of the long term consequences.
Notwithstanding all of this I gained a degree,, continued to work as I still do in my chosen field and am well regarded by my peers. My mental health may have fallen into a heap but somehow I maintained some semblance of normality.

I ceased seeing my psychiatrist at about the same time (early 80's)and not until the late 1990' did it all catch up with me realising something was seriously wrong and so decided to seek treatment again with the same doctor after nearly a 20 year gap. This time however I took it seriously and along with medication I embraced the cognitive therapy I was offered.

I have described my history to put into perspective one of the key things from a (this) patient's viewpoint that determines whether xanax is a suitable drug and that is the necessity to have an acute awareness of the illness for which it (and other medications) are prescribed. I am fortunate that I have a high level of understaning of my disorders and a well above average intelligence and instead of reaching for more xanax I use the cognitive therapy I have been taught as an adjunct to the medication. On average I would use 0.25 mg a day and do have extended periods where I don't use it at all.

I may be the exception in the use of xanax but your comment about the brains laziness is spot on. As my dosage is quite low it is relatively easy for me to wean myself off if without any significant withdrawal symptoms and do not find that I develop a tolerance to it. I do admit that it can take the edge off of anxiety but using it in association with mindfullness and my antidepressant (reboxetine) allows me to use it in an appropriate manner without the need to abuse it. Hopefully I left my abusive behaviours behind some years ago.

I do take issue though with your "rules of thumb" though, in that points 1 and 2 are contradictory and that at least from my perspective they are somewhat alarmist. I understand the consequence of the points you make however they are not unique to xanax and indeed can apply to many things that are open to abuse.

I am also greatful that my country of origin (Australia) has a universal health care system where treatment is either free or 85% of the cost of a psychiatrist is paid by the government and medication is subsidised.

Anonymous said...

Here's what one psychiatrist writes in his blog:

"One myth that complicates the use of BNZ by doctors and patients is that they are “highly addictive”. The fact is that if they are taken regularly, so that they are always in your system, over time you develop a physical dependence. This means that you have physiologically adapted to the medication, and if you stop it suddenly or go off it too fast you can have withdrawal symptoms. But, physical dependence has nothing to do with addiction. Addiction is compulsive behavior in spite of negative consequences. Most people take medication to feel more normal and to be able to function. Addicts aren't interested in feeling normal. It's either “too boring” or “too stressful” or both. They prefer to be “high” or “numb”. The small percent of patients who abuse bnz's are usually wanting to be numb. But this is less than 5% of patients who are prescribed one of these medications. Pain meds, especially hydrocodone types, are 3x more likely to be abused." Source:

Anonymous said...

Ok heres my take. I am not a doctor, pharmacist or any kind of health care provider. I am a regular person with some mental/nervous problems. I was on MANY different ssri's for many years for depression and anxiety disorder. NONE of the ssri's EVER helped me. And when i stopped taking them, especially paxil, I had horrible withdrawls. Then i was put on xanax 1mg 3 times a day by a new doc. I never felt better in my life. It wasnt a high feeling but a feeling of normalcy which is rare in my life. I was finally able to function well at my job, with relationships,.... with every aspect of my life! Then the doc took me off the xanax shortly before relocating his practice to another city. I started going to a new doc and he prescribed the xanax once but would not after that. I finally stopped seeing this doc because he kept trying to push ssri's on me even though he knew they had never helped me and i HATED them. So i finally gave up entirely and just started getting them on the street. Just let me say running out of xanax is HORRIBLE! The worst withdrawal i've ever experienced or seen. I still take them whenever i get them because without them i am not the same person. I am never ever happy no matter what. never in a good mood. Not able to perform my job 1/2 as well. Nothing. I just have one major question. This medication is made for people that need it. If it's not given to those who need it why make it? I still havent tried to get them from a doc again because i'm tired of being looked at as a pill head because i'm not. For some, it can be a miracle drug.

Anonymous said...

I have found the majority of physicians and psychiatrists completely ignorant these days. Take for example when SSRI's became popular and patients were complaining about the horrendous discontinuation symptoms and they dismissed them as false. Now it's pretty common knowledge. They would rather listen to the pharm companies than their own patients. Maybe they should start taking some of these drugs they are prescribing then they will understand.

My pysh prescribes me almost everything under the sun to try and get my GAD under control-Lexapro, Paxil, Zoloft, Remeron, Lithium, nuerontin, abilify, serax, klonopin, and valium. For me the benzo's that work the best are klonopin and valium. I have been on valium for the last 4 years but still have alot of break through anxiety and wanted to try xanax but he absolutely refuses to presribe it but has no problem prescribing hard stuff like abilify, lithium, etc. so I was forced to order it off the internet from an illegal pharmacy. I have 90 serax pills in my cabinet, 60 klonopin pills with 2 refills at the pharmacy, 60 valium pills with 2 refills so if I wanted to abuse them I would just pop 3 or 4 valium at once and would get a pretty good buzz but that's not really my objective. I want something that works and if the xanax works better then great. Chances are it won't but it's worth a try for a few weeks to see. Also, for the doctor that said they like to prescribe Ativan-are you kidding me? It's not much different than xanax. It has such a short half life. When I got some I was going through withdrawals between doses bad and quit after 3 or 4 days. Why would you choose ativan over xanax when they are virtually identical in their half-lives?

Xanax has a bad rap and I don't have much experience with it so it may be true however all the benzo's have similar risks-some just have longer half-lives than the others hence being a little smoother. It's just so interesting to me that they have no problem handing out ssri's like candy which many have debilitating side effects and withdrawals but freak when it comes to prescribing a benzo besides the all to popular klonopin which is being prescribed by most pychs these days. Seems to be the new fad.

I have one day experience with xanax because I just got it from an online pharmacy and I would of much rather had my doctor prescribe it and monitor it but he wouldn't even though he knows I have been on every other benzo out there. It's just annoying. I am aware of the xanax and scared of it a little because of what I've read so I'm treading carefully. Chances are I won't like it and just stick with the valium. However, there is alot of info out there and many docs prefer xanax as the first line of treatment for anxiety disorders because it seems to be the most effective. Again, I don't have much experience if any with xanax because today was the first day I took it. Took a .5mg and it knocked me out within a few hours. I am still taking about 5mg valium with it as well. I may take some tomorrow or I may not. I don't know. Just looking for a little more anxiety relief and the valium may be my best best or xanax may be the answer. I don't know. However, some docs out there need to wake up and quit thinking everybody that wants xanax is an addict.

Anonymous said...

I'm NOT a doctor...however, as a someone who has had treatment for panic disorder...I will tell ya'll this...For ME...xanax is the ONLY thing that has helped me cope. I have tried all the antidepressants, buspar.this is the only thing that works for me.

not everyone is like me...I just want to make it clear that I am one person who is having a hard time getting the meds I need because of the bad word on them. It helps me function when nothing else has. I take less than was originally prescribed, weaned myself from 5 mg to 1.5 mg and now am having an impossible time getting's quite ridiculous...for some of us with anxiety this IS the only medication that helps... I guess thats all I have to say...

Anonymous said...

Just curious, if xanax is the only thing that works for some people...what is the problem with it? I don't's basically like this in my opinion...say you're diabetic and you find the right medication...or you're inclined to have hypertension or find the right medication...and it you look for reasons to change it? No... you continue with that therapy...Panic disorder can be treated and controlled, but if the hypothesis out there is benzodiazpene's are not it and anti depressants are and they don't work for all people, you're basically saying..."you have cancer and this(anti-depressants..etc.) treatment does not work for you so you're screwed. Why don't you all consider that all people are NOT created the same...different chemistries etc. Just my opinion... Don't have a doctrite or anything, just a product of the almighty..thanx

Anonymous said...

Let's just say I have a background in pharmacology. :-)

I was on alprazolam (Xanax) 5.5mg per day in divided doses for a severe case of panic disorder with agoraphobia. I took it on prescription for three years as directed.

Although I was calm during the day, I kept having nocturnal panic attacks almost every night, which was probably due to the short half-life of alprazolam, so I decided to try to taper off very slowly. I tried reducing the dosage by 0.25mg but woke up with tachycardia and sweating along with a sense of tension. I realized that this is probably withdrawal and not relapse (i.e. the original condition for which I was treated returning)

I decided to ask my psychiatrist for a diazepam taper and he switched me to an equivalent dose of diazepam (Valium) and I stopped the Xanax abruptly.

The dose of Valium was 80mg the first day, 60mg the second day, 40mg the third day and 20mg (5mg q.i.d.) the fourth day. I remained on 5mg qid for the next year and then tapered down to a tid schedule.

Now I'm only taking 4mg tid (two 2mg tablets three times daily).

I do not have any nocturnal panic attacks on diazepam but it causes a lot of daytime drowsiness and tiredness and I don't like that, but my options are limited. I probably also have sleep apnea (which began the first day I took BZDs in 1990. I would wake up gasping for air and my roommate said I began to snore the day after beginning BZDs), so this is another motivation to reduce the dosage.

I found an antidepressant called Stablon (tianeptine) which is produced and marketed in France and a number of other European and Asian countries. It is a tricyclic antidepressnat which works in the opposite way as SSRIs as an SSRE (Selective Serotonin Reuptake ENHANCER).

Stablon has no sedative or libido-lowering properties. It has kept me out of major depression for the most part (along with light therapy), helped my asthma and has indeed reduced my anxiety. In fact, because of Stablon, I was able to reduce the dosage of Valium from 5mg qid to a current dose of 4mg tid without any problems. Dosage was reduced by 1mg per month.

People try to taper from BZDs too fast in most cases or inappropriately. Xanax can be hard to taper for many folks due to its high potency and short half-life.

However, if Xanax is working for you, don't quit taking it. "If it ain't broke, don't fix it".

If Xanax is giving you rebound/interdose anxiety as it did with me, then consider having a talk with your psychiatrist or other prescribing physician and consider a cross taper to diazepam.

Diazepam is the most rapid-acting BZD and it is also very long-acting and relatively easy to taper relative to other BZDs.

I wish there was something less sedating in the BZD class. There is clobazam, which is a 1,5 benzodiazepine and is anxiolytic and anticonvulsive without the sedative effects, but the anecdotes I've read so far don't give me much hope in that medication. Clobazam (Frisium) is very popular here (often in combination with an SSRI.. SSRIs destroy my sex drive and some patients have had permanent loss of libido.. there are case reports of this them!).

I understand that in the US (where I used to live), the popular combination is/was sertraline (Zoloft) and clonazepam (Klonopin).

Xanax is not very popular here either, although it is not frowned upon as much here as it is in the US.

I must admit that the first day on diazepam, I still felt some sort of "withdrawal" from Xanax. It was a feeling as if my head was a TV camera and I felt stiff all over, but the next day I was fine.

I don't have any desire to take Xanax again. It never made me euphoric and I never developed a psychological dependence, but definitely I had a medical dependence (physical dependence) on alprazolam.

In fact, if I can ever manage to taper off diazepam and just rely on Stablon for panic control, I will do that, but 12mg/day of diazepam seems to be the minimum needed to keep the panic attacks away. That is considered to be a low to moderate dose in the US, but here it is considered to be moderate and anything above that is "high".

I've been on BZDs uninterrupted (for the most part) since 1990. That's 18 years of daily use under the supervision of a psychiatrist.
(I've been on Stablon for 3 years)

Google Stablon. It is non-sedating, is free of cardiotoxicity and does not affect sex drive. It has almost no side effects for most patients.

If you live in a country where you can get Stablon or if the FDA will let you import Stablon into the US in small quantities, then go for it before trying a BZD.

Another tip which you may find helpful: gluten-free diet
That has also reduced my anxiety by 50 percent.

Also consider light therapy as an adjunct (or alone) in the treatment of depression and anxiety. Yes, it can work for anxiety. :-)

Good luck.

Anonymous said...

Worst ever playing with the devil I so call it.Ended up in ER withdraws are horrible DOCTORS SHOULD BAN OF THE MARKET...............DEADLY IS ALL I CAN SAY

Anonymous said...

People need to learn to taper properly and there most likely won't be a problem.

I often hear of people saying, "I went cold turkey off Xanax and felt like I was going to die. Let's BAN this drug!! It's the devil!"

Well, have you heard of tapering? You can even taper as slow as 0.125mg per month. Shouldn't have any problems if you do that.

Dr. Stuart Shipko, a private practice psychiatrist and neurologist in Pasadena, CA who has treated over 2500 panic disorder patients says that although Xanax withdrawal can be bad, he thinks that SSRI withdrawal is worse.

canadaorbust said...

xanax is not so bas as long as someone does not exceed 4mg a day plus drugs like ativan last longer and act more as sleeping pills than things to kill a panic attack and have way more horrible withdrawls like tremors and other nightmare like symptoms.

Anonymous said...

"Some prescribers think it is a good antidepressant (it's not)"

That's your opinion and it's not based on very solid evidence. There are a number or more recent medical abstracts showing that alprazolam increases levels of norepinephrine, increases serotonin levels in the hippocampus and acts on beta-adrenergic receptors, unlike other benzodiazepines, thus inducing an antidepressant effect.

I've been on alprazolam for 20 days for panic disorder and my depression is in total remission. Prior to that I was on Valium for years and was getting steadily worse in terms of depression and dyscontrol/disinhibition. I was yelling and throwing things all over minor incidents which wouldn't anger most folks to that point.

I thought maybe diazepam was exacerbating my anxiety, and although alprazolam has an undeservedly bad reputation because of the bad actions of a few who abuse it, I no longer feel angry anymore.

Everyone says I am a changed person in a major way. I drop something on the floor or bump into something and no longer fly into a rage. In fact, I don't even become angry to begin with. I no longer feel that God hates me or has cursed me or that the neighbors wish I was dead.

I feel stable and not depressed in the least.

No, I don't work for Pharmacia-Upjohn or Pfizer or whoever markets this now out-of-patent medication.

If Xanax was really that bad it would be in Schedule II or III rather than Schedule IV.

I do think prescription should be restricted to those with panic disorder who haven't responded well to other benzodiazepines and it shouldn't be given PRN. It should be used on a regular schedule to keep the panic attacks in remission and as panic disorder is a lifelong illness with serious cardiovascular and mental consequences (e.g. heart disease, suicide, stroke), it should be prescribed for life.

There are also plenty of abstracts showing that alprazolam retains its anxiolytic efficacy in the long term (there was a 10 or 20 year study and Google/Pubmed is your friend).

Yes, it does have an antidepressant effect. There was even a double blind study where it was used as monotherapy for major depressive disorder and most of the patients went into remission.

I think most doctors don't like alprazolam because they are young, cocky and unduly influenced by big pharma drug reps.

Whoever thinks that Valium is less of a problem, think again. At least with me, I was snockered all the time on Valium, even on a low dose. I felt heavily sedated and sometimes had amnesia when I took only 5mg extra prior to exercise to prevent exercise-induced panic attacks (the whole sodium lactate thing.. I'm sure you know about it). My short-term memory would become shot and I was actually scared that I would lose my mind or do something uncontrolled.

Well, with alprazolam I don't feel sedated whatsoever. It's like I'm on _nothing_ at all, which is great. At the same time, no panic attacks. Bingo. I think we have a winner here.

If this so-called "doctor" doesn't think that alprazolam really works for anyone or that "Some prescribers think it is a good antidepressant (it's not)", then he's truly full of s***. Pardon my French.

Anonymous said...

There is a benzodiazepine that even this bigoted doctor would approve of.

It was produced in 1976 in Hungary during the communist era. It is called tofisopam (Grandaxin).

It has no sedative or anticonvulsant effects. It only possesses anxiolytic activity and as far as has been observed in Hungary, there is no dependence liability.

It is a 3,4 benzodiazepine. I'd love to be able to take this. Imagine having no sedation or other interference with mental function, yet also being free of severe anxiety. I think that would be great.

I wonder why that isn't marketed in the US? Oh, I know. It would put the SSRI manufacturers out of business. I bet a lot of patients would have a lot less depression if they could actually have a non-sedating anxiolytic drug without the risks of physical dependence!

Anonymous said...

I think medical professionals dislike Xanax because medical professionals take a great deal of Xanax. The standard scenario is that it is first prescribed legitimately, and then the dose is escalated, and the prescribing doctor gets that "look". You know the one: the "you are abusing Xanax" look. So, the doctor begins self prescribing, and little by little the dose creeps into the stratosphere. Soon, the doctor's brother, sister, mother, dog, etc. have prescriptions called in for them. Fortunately, the doctor is there to pick it up for them. The stresses of a busy medical practice cause the doctor to feel as if he cannot function without the drug, and it probably gets to the point where he practices better on Xanax than withdrawing from Xanax. Attempts at self detoxification lead to the rebound anxiety, insomnia, etc...and ultimately the good intention goes out the window. One little blue pill fixes it all. If the doctor is candid with himself, he realizes that he has a problem, and this makes him anxious...blah blah blah...and he fixes this with a little pill. The doctor knows from his own practice that Xanax seekers are an especially difficult drug seeker to divert, as is the doctor himself. But after all, "Nobody knows the trouble I see", and the problem continues to escalate. Then bad things happen (someone hosts an intervention)...then good things happen. You are inpatient at the Betty Ford Clinic, and they get you off the xanax; the next 2 months are finding out why you went there in the first place, and helping you to never go back. After all, Mrs. Ford really built a nice facility; I know first hand.

Xanax has a legitimate use, but the secret to Xanax is to NEVER
increase your own dosage. NEVER.
If you need more, you need to sit down with your mental health professional and discuss it with him.

First Hand Experience

Anonymous said...

"Xanax has a legitimate use, but the secret to Xanax is to NEVER
increase your own dosage. NEVER."

Well, that's not just a secret unique to Xanax. It's a rule to observe with all medications, scheduled/controlled or not.

Whenever you need a dosage adjustment of ANY type of medication, be it for anxiety, heart disease or diabetes, ALWAYS discuss it with your prescribing physician. Never be your own doctor.

Anonymous said...

"my sister has become addicted to xanax,& has had two major seizures"

Xanax does not cause seizures, abrupt withdrawal (e.g. "cold-turkey") from Xanax can, albeit rarely.

The vast majority of folks prescribed benzodiazepines (BZDs) do _not_ abuse them or become addicted.

The definition of addiction being someone who loses control of his/her usage, increasing/escalating the dosage well beyond prescribed limits to achieve an altered mental state or "high" (euphoria) with no concern for bodily harm or injury or infractions of the law that may result from abuse of the substance.

Physical dependence is not the same thing as addiction, although addicts often are physically dependent on the substance they abuse.

Like chronic pain patients who take opioid analgesics long-term for pain management without loss of therapeutic benefit and without addiction, folks with anxiety disorders who take Xanax also fare just as well.

A ten year study has shown sustained efficacy during long-term treatment with alprazolam (Xanax) in panic disorder patients. The dosage was not increased and, in fact, most patients tended to decrease their dosage over time. Tolerance to the anxiolytic effect did not occur with long-term use, thus proving the safety and effectiveness of alprazolam for long-term therapy.

Anonymous said...

It has changed my life for the better. I have sufferd from major panic attacks for longer then I can remember 15 yrs+. My main problem with my panic attacks are being in moving cars. For some reason I get major panic attack in cars be it driving or being the passenger. And it has hinderd my life trmendusly. Just to go to see a friend or goto the store was a big deal. As a result it made me stay home for weeks on end.

After so many years of this my mom convinced me to goto A doctor. I did not want to as I had a feeling that they would pre judge me and think that I was there for drugs and drugs alone. I have a lot of tattoos and I just dont look like somone that would have this problem. Not that I feel you have to look a sertain way to have a disorder. But I look like the typical stero type of the counter culture for lack of a better term. So i went to see a doctor. And low and behold they thought I was there for drugs and drugs alone. They even said so. And would not give me xanax. They gave me something else called visterl or something like that the name slips me now. Well I had major side effects from that. I slept for 18 hrs a day. And it made me have a very short fuse just short temperd over the slightest things. I told the doctor this, and asked for xanax as I have tried it befor for my panic attacks and I knew that it worked very well with no side effect. She told me no that I was to young for that and that she feels that I am there for drugs and drugs alone. I told her that I am almost 40 yrs old, and asked when she felt I would be "grown up enough to take it". She told me to keep taking what she gave me untill I see her next month. I told her no I will not and I would like to cancell my appointment as you are doing nothing but judgeing me as a stero type that you think I am and not treating my problem.

I then went to see the doctor that my mom goes to. Very reluctently I might add as I felt that the out come would be the same. But I went, and all went well. He gave me a small does of xanax to start with only 0.5 2 times a day. I have since had the doesage up to 3 times a day. But to make a long story short. I one day my problem is gone. Something that has ruined my life for a long time is gone. My quilty of life has improved so dramticly that words could not describe. I get out and see friends all the time. I am no longer a hermit because of fear to leave the house and drive some where. With no hesitation I just get in the car and go. I have no side effects what so ever.

It has been about 7 months since I started taking xanax. And it has been a dream come true for me. And as far as the short half life. It seems to me that this is only partly true. Like I said I just get in the car and go. Well some time I might forget to take my 2nd does or forget to bring some with me. Well yes it does seem to only work for so long. But I have noticed that even if it has been say 10 hr since I took my last does. There are residual effect that linger on pass that 6 hr mark. I can feel the panic attack coming on, but it goes some what away and is somthing I can handle at least untill I get home. Nothing like I had befor taking xanax.

Because alot of doctors feel negitive about this drug for many reasons. I feel that we the people who need it are the ones made to suffer. I really dont care if it is addictive as I would rather live a more fulfilling life and have to take a pill 3 times aday. Then live the live of a hermit and say at least I am not on drugs.

Granted I know I am on what is considerd a small does. And I am happy that my body had such a positive reaction to a low does. And as of yet I have not had to increase my doesage at all since the second week of taking it. And if I am not going to do anything on a given day I do not take my second pill. And I do not notice any ill effects or withdrawl from it as desribed in the artical.

Once again I love this drug and has changed my life. I feel that at 36 I am just starting to live my life again. And if you read some forums from the people who take it. Most feel the same way, as I am not alone in feeling this way.

Sorry so long of a post but I just wanted to let any doctors out there to know the other side of things. Dont Let what you read in a book stop you from treating some one with this drug. Put yourself in their shoes and think of the pros and cons. My life Is so much better because my doctor has this mentality.

Thanks again for reading

Anonymous said...

Could the doctors posting here please tell me if in their opinion it is at all possible to become addicted to taking 1/2 of a .25 of Xanax about 4 nights a week to sleep? I am extremely sensitive to drugs and years ago had a psychotic reaction to taking ONE 30mg Imipiamine tablet one time only. Sometimes I forget to take the Xanax because I am sleeping ok and go 3 to 5 nights without it, when at that time the stress will build and I notice I am getting a bit nervous, talking alot and anxious. Then I begin the nightly routine again. I have taken this drug for 20 years - the first 15, I took 1/4 of a .25 at night to sleep and 5 years ago, began taking 1/2 of a .25 to sleep. I rarely take it during the day except if I am panicking about 1 time a month or less. It totally normalizes me to where there are no racing thoughts, no pounding heartbeat, and no insomnia. I can function normally during the day and don't have panick attacks when I go out in public places.
I just saw a medical doctor who threw a fit, telling me this is an old drug that is not prescribed anymore (I have PTSD and DID) it is extremely addicting and that I need to see a psychiatrist who she admitted presently give a "cocktail" of medications. She told me that currently ONLY antidepressants are used reduce anxiety caused from PTSD.
I would assume by my experience with the one Imipramine tablet which kept me awake the entire night with a dry mouth waking up and gulping water, having violent feelings for my toddler who I was living alone with (and with no phone to call anyone) and visual hallucinations, that I would not be asked to try (experiment with) antidepressants at all. I have read the Physicians Desk Reference which states that at levels of 4mg or higher there is a risk for Xanax dependence and nursing manuals that state that if a person has an adverse reaction to an antidepressant even the older ones they should not take the newer ones as they are all under the same classification. I stopped taking my Xanax on purpose three days ago because I was running out and was trying to space out the doses as to not run out all at once. I was told this doctor would prescribe it for me by the clinic office and it would not be a problem. The first night I felt nothing and slept well. The second night I fell asleep but woke to the sound of my heart pounding but felt nothing. The third day I was feeling a bit anxious (perhaps at the thought that I was running out - I had 4 doses left - 2 .25 tablets). I ate dinner a bit late about 8PM and afterward started panicking with my heart pounding and fearful thoughts. I got up and took 1/2 of a .25 and in a couple of hours calmed down. It is my experience that this panic does not subside over time. I have been without this medication for weeks at a time attempting to find a doctor who is willing to prescribe it, so I know that the panick comes back and does not subside. And the lack of deep sleep probably doesn't help me either.
I saw a psychiatrist about 6 years ago who told me he could not get the dose of the other (in his opinion better) medications down to the level of the 1/4 of a .25 of Xanax and I should continue taking it.

Anonymous said...

I have a 10mg prescription for Xanax for panic when I fly. I have noticed myself getting confused, irritable, wound up, and anxious when take it. But... I never remember anything so forget that it didn't really help. I usually take only half a pill! Since I have Lupus, I am hyper-sensitive to most stuff. Today, I had to take an Open MRI so I took a Xanax an hour before. 10 minutes later, before I even left the house, I was irritated, confused, and sweating . I got to the the MRI machine, which looked perfectly open and comfortable, and totally freaked out so I could not do it. I think I had better find a different anti-panic drug!!! i would have felt better if i had taken Nothing!

Anonymous said...

I'm not a doctor and I'm grateful for the good doctor's explanation of what happens in the brain (GABA).
However, even before learning about the brain chemistry here I already knew why it was addictive... and why I would be one of it's victims if I wasn't so scared of ruining my life's absolutely wonderful!!!
It's like a reset button. If you are having a terrible experience(panic attack or you just can't sleep), you can take one of those little footballs and BAM!!! It's the next day! It's like a terrific little "do-over" with no hangover.
It was prescribed for me a few years ago when I complained to my doctor about trouble sleeping due to my anxiety about my up-coming tummy tuck surgery. I fell in love.
After the surgery when the pills ran out I was ashamed to ask for more b/c I knew I didn't need them...I just liked them.
Anyway, thanks to the good doctor for the science behind the "wonderfulness". I guess life rarely gives anything good without a price tag. It's like smelling a rose and getting stung by a bee!

Anonymous said...

From Conrad to Roy,

I just wanted to say thanks for your post but - question - About your advice, it was to take a xanax when you feel a stressful situation or panic attack coming on, well unfortunatley, in my job there are LITERALLY several situations that qualifiy in this dept. Some more minor, and some can be -SERIOUS- sweating and paperbag breathing in private (believe me, i have done this a few time due to impossibe deadlines and short staff at work long long work hours and still having to take care of the kids after work... you know what i mean. Anyway, if i took a xanax eveytime these thinge happened everyday, i would overdose, or at least build up a intolerance. either of which would be an undesired outcome. My question, what advice do you recomend for a high stress, full till throttle enviroment like mine and many others in the same situations nowdays?

Anonymous said...

Rule number one is to NEVER chase anxiety. So when a patient with an accurately diagnosed anxiety disorder is taking Xanax(Alprazolam) they should not be popping it like a candy pill when ever they begin to feel a bit anxious. The triggers for the anxiety are numerous and varied so it is difficult for a patient to identify all of them before they find themselves right in the middle of a full blown panic attack. Xanax should be prescribed only to those patients who absolutely need it and who will adhere to the dosing requirements. If a patient begins to not derive benefit from the Xanax then it means they are developing a tolerance to the medication and it should be slowly removed. Not every patient develops that tolerance. There are patients who can take Xanax (say 0.5mg-4X/day) and their anxiety is controlled without chasing it or without a need to increase the dosage. So direct and honest communication with each patient is really very important with this type of medication. If the patient knows he or she will be in an anxiety producing situation, then the dosing for just that one day can be moved closer together to provide more coverage. In all cases of misuse and non-adherence to prescribing guidelines (abuse), the Xanax must be slowly eliminated. I find that most psychiatrists lack a really solid understanding of psychopharmacology, which makes playing with medications very dangerous!

altostrata said...

"Some of you" is right. Other psychiatrists prescribe Xanax and other benzos as though they were vitamins. Psychiatry has also persuaded its colleagues in other medical disciplines these medications are safe. So there are plenty of benzos to go around.

I had Paxil withdrawal syndrome and within a short amount of time I was prescribed 5 different benzos by various doctors and I didn't even want the prescriptions -- I am hypersensitive to benzos. I even told the doctors that.

Did any of the docs follow up? Nope.

Some people get benzo withdrawal from very short, low exposures to ANY of the benzos. Benzo withdrawal syndrome has a lot in common with antidepressant withdrawal syndrome. It is a living nightmare. It can kill people. And it is very, very common.

In terms of withdrawal, the distinction between the addictiveness of benzos and dependency caused by antidepressants is meaningless.

Then there are also the problems of paradoxical reactions to benzos and addiction -- about which doctors in general as well as psychiatrists are ignorant.

How can psychiatrists continue practicing knowing nothing about the drugs from which they're making a living? Is a conscience amputated in medical school?

Adverse reactions, dependency, addiction, withdrawal -- who cares as long as you can collect your fee for a 15-minute prescription maintenance visit.

There are no safe benzos, not even Ativan. Funny how only some patients know that.

Btankey said...

Funny, my experience with xanax seems to be somewhat unique. I do have a history of alcohol abuse and when I started taking xanax in much the way Sarebear describes, I also drank less, while only taking, on average .25mg doses once or twice a week. I feel it has been beneficial to me, and I guess I'm aware of the dangers and simply try to avoid them. For myself, I also see an analyst 4 times a week, which helps with anxiety, but my point is, I guess, the issue is complicated. My alcohol abuse did not translate into an addiction to xanax, and in fact helped me reduce my drinking. The benefits of xanax, so well described by sarebear, are worth considering alongside the dangers.

Anonymous said...

Sanjay Gupta did a piece about how addictive Xanax is.

Anonymous said...

Dr Sanjay Gupta did a piece on how addictive Xanax can be.

moviedoc said...

That's not fair. You failed to mention the extended release version with longer duration of action, although the elimination half life is still short.

Don't prescribe (or take) that one either, for all the other reasons.

robbie said...

I realize this is an old conversation but I just happened upon it and have a situation that I can not find addressed anywhere. I was diagnosed with an accoustic neuroma about 9 years ago and had gamma knife surgery on it at Brown in RI. I was left with tinnitus at 80 decibles. It is extremely intrusive and I am aware of it 100% of my waking hours. I have seen many specialists went through TRT (Tinnitus Retraining Therapy) ... one very highly regarded Dr perscribed Xanax XR for the tinnitus... I was in such a state that sometimes just walking into a room and changing the accoustical envirnment put me into involuntary tears... like my body was crying and I had no idea why. The Xanax XR was very helpful... I can not say I ever feel high or get a rush. I have been taking it for the past 7 years. I did decrease the amount a couple years ago... I did not tell my Doc... I just did it. Until this issue... I had not ever been on any medications except an antibiotic here and there. I am in my 60s now..

Is there anything that you know of that would be as helpful as the Xanax XR is for the extremely loud tinnitus. Xanax does not decrease the sound... it just keeps me from reacting to the sound. I am open to anything. Right now I have been looking into GABA and Melatonin because I am suddenly having trouble sleeping. I tried an Ambien and was literally wide awake for 2 days. Not going to try that again. Any suggestions?

Shannon said...

I take xanax illegally because I have social anxiety and prefer to self medicate. I have been addicted before, but if you just take a section you won't have bad withdrawals. I can't imagine a first date, job interview, or family reunion without it. I barely ever take it except for situations I know I literally can't handle. I have embarrassed myself many a time because I can't control my anxiety in certain situations. Above all I don't want to take an SSRI everyday and feel nausiated and sesless. I haven't found a doctor to prescribe me it, so I have turned to the black market.

Anonymous said...

I have been taking between a quarter mg and a half mg since 2001. I have never abused it. As a matter of fact my long term doctor of 25 years put me on it when I started having feeling like I was having a heart attack. After several arguments....him saying I wasnt't and me saying I was having a heart attack he slapped a halter monitor on me for 2 days monitoring my heart. After removing the halter monitor he tells me I am fine but suffering from anxiety. I laughed. I have never abused it. I am prescribed 2 mg a day but take very little just to take the edge off one time per day. I have decided to try something else and my new doctor put me on trazedone. I do have a doctor who will write my script for alprazolam but after listening to all these people who want to be know it alls I have given this other a try. Yes I still have my heart feeling going on but if it finally ends in a heart attack so be it. It's really a shame that all these fn morons who abuse perscriptions have made it hard on those who take it for a reason. Remember folks....there are those who don't abuse scripts

Anonymous said...

sorry....I meant between a quarter and a half MG not both....have a good night

Scream said...

Klonopin lasts for too long and makes you stupid for too long. Xanax works fast and you're not stupid in the morning, but you may have to take another one at 4 am to stay asleep.

I have a nuerolepic induced movement disorder or maybe it's just PLMD. Either way I can't take dopamine blockers. Being very prone to mania, I also can't take anything that messes with serotonin such as risperdal.

I also think that biological psychiatry is a load of B.S. so I'm not much interested in the latest and greatest newly patented drugz.

But I do realize that taking xanax every HS is better than three days with no sleep, delusional mania and broken bones.

Now read here that xanax is promanic. Hmmmm

BPladybug said...

My first Psychiatrist gave me Paxil which induced mania and landed me in the ER. Then Depakote and Xanax. .25 four times a day. I was concerned about addiction, we discussed it, and she felt I needed it. I took that dose for four years! That doctor retired. It took me two months to gradually wean myself off Xanax. Now, with a new doctor, I have much more stability and less anxiety on a Lithium/Seroquel/Neurontin cocktail. I still have a prescription for Xanax and I take .50 occasionally. However I never want to have a physical dependence again. I have no problem with occasional usage. It works great for claustophobia and anxiety in a large loud store such as Costco. I think it is a useful drug and not a road to addiction for me. I don't think Xanax should be demonized.

Kristi said...


I've had a really positive experience with alprazolam (generic, cheaper). I take .25 to deal with anxiety/dissociation and .5 in situations of extreme anxiety (panic attacks) or to regulate sleep. I'd say I might take it twice a week, though I take more often when travelling (time zones, and to be calm and sleep on planes). I often go weeks without taking it.

I have DDNOS, PD/anxiety and CPTSD. I like that this is a drug I only take as needed (and apart from tryptophan occasionally to sleep this is all I take). I've had lengthy conversations with my psychiatrist about addiction, and how frequently it is okay to take it. He said basically that up to 4-5 times a week can be okay. I seldom take it that often.

On a few occasions I've taken .25 every 3-4 hours for a few days (only when in an extreme state in order to enable myself to be calm enough to do all the healthy behaviours that will help).

I think the warning about addiction is an important one - but for some of us this can be a really helpful drug. I much prefer this option than being on an SSRI all the time.

Unknown said...

I agree most doctors that are new know nothing of real panic disorder and are listening to what is going on with abuse of the xanax drug. I am a real panic disorder patient since the 90's. I am 35 and shrinks have used me as a guinue pig thinking anti depressants work and they dont. Panic=hyper meaning you need a sedative not a happy pill.

I am extremely pissed because doctors are being stupid not prescribing more dosages because now its labeled a street drug and automatically you are considered a junkie if you are on xanax.

well guess what, "xanax saved me many times when no other stupid pill like traxene, buspar, librium, i mean you name it i took it and for me xanax was the only thing that made me not go on disability.

yes it is short acting and not a cure but some of us DO NEED this pill at a correct dosage meaning more than the petty you guys have been prescribing because some of us have a reallll ill ness you wont understand or even begin to feel. Many times I had to get this in the street because of idiotic doctors that do not understand what panic is. Maybe if they throw a plastic bag over their head and breath in to know how we feel then they wont be so picky on meds.

Klonopin btw is really great for long term panic to be controlled but if you miss a day you will suffer really bad with withdrawel symptoms.

Anonymous said...

I am 58yrs old and have been taking the same .25 nightly dose for 16.5yrs.
For me it is a miracle pill. Doctors, please recognize that some people truly need Xanax. I take a generic for panic disorder and also depression. I also take Paxil but Xanax in my opinion helps a lot for depression, maybe more than the Paxil. I have never had problems with Xanax and have not needed to increase the dose. That's my story.

Roy said...

We do recognize that some folks do great with Xanax. Yours is a great example of that, Anon.

Anonymous said...

I began having severe anxiety/panic attacks post delivery of my children approx. 3 years ago. Xanax gave me my life back. After 2 years of taking this drug daily at a small dose I stopped using xanax and became pregnant with minimal side effects none as severe as listed. After the delivery of my second child symptoms returned and so I have began the xanax again but with much control. I feel this is a good medication for those who are responsible with it and maintain a small dosage.

My question is can panic be hormone related??? Seems it returns with the birth of my children???

Rob Nitschke said...

My Mother was experiencing servere pannic attacks which were making her physically ill. Mums blood pressure would go high and her heart would race.
The immediate action from all Doctors was to treat the high blood pressure and not the cause.
3 years later and a lot of feeling ill from rejection from blood pressure medication, Mum called the Ambulance. When they put her in the van she was given Xanax.
Mum said God visited her that day and gave her a miracle. Since she has been taking Xanax she has a new lease on life and is so happy.
Mum has to put up with annoying reccomendations to quit the drug when she asks for repeats yet none have an alternative.
Just like poor mechanics and bad carpentry why do Doctors think the're exempt?
In this case Xanax works well and should not be dismissed. Doctors do not visit anymore like the used to so how could they possibly know what is really happening at home?

Anonymous said...

Anon, I strongly believe that anxiety can be hormone related. I had a history of anxiety which subsided while I was pregnant/breastfeeding (x2 kids) and came back after I discontinued nursing. Additionally, I can accurately predict the onset of my period because I experience increased anxiety two days prior every month. I have been on Xanax at a low dosage for 5 years, and it has given me my life back. I had debilitating anxiety to the point that I could not set foot outside my house without a full-blown panic attack. With the medication, I feel normal. I do worry about the long-term effects, but I take my medicine responsibly, and as prescribed, and follow up regularly with my physician. To me the benefits far outweigh the risks, at least at this point in my life.

Xanax said...

Excellent for anxiety, especially if you start with the minimum amount, 0.25 mg and only take more if needed. I say this because I was prescribed 0.5 mg 3x daily and don't need that much. Try to take the least amount and if that works don't take more since you can build up a slight tolerance over time. My only concern is will I ever be able to be off of medicine. I just wish there was a natural cure for anxiety. I hate being dependent on this.

Divrguy said...

I have been on Xanax for about 15 years. I am prescribed 1 mg per day and 3 times a week I will brin my dose down to 2/3 to 3/4. I have tried to go off twice now and found myself extremely irritated at myself that my OCD increased, lack of anger control and patience and general well being all but diappeared. I am still amazed at how Xanax has helped me but fel my time is running out for risk factor roulette. I feel it has saved my life and marriagem I hope it doesnt kill me in the process.

Anonymous said...


Noah said...

Referring to Divrguy, you take 1mg of Xanax only when you need it and that is normally three times a week correct? If so, I do not see why you are trying to quit. You should save yourself the anxiety and take your medication! Stress may kill you! If your dose has not risen dramatically over this long period of time then stop hurting yourself by trying to stop.

Anonymous said...

I've taken this drug, given to me by my friend - my "psychiatrist" - let's say.

Just another opinion for ya. If you ask me, you folks should be prescribing cocaine for people needing speeding up, and marijuana for people needing slowing down. Less side-effects, proven over decades to be relatively safe, and shucks we can keep some green away from Merck and their ilk, too. At least we'd be financing something exciting.

Furthermore, you should basically be giving your patient whatever he or she wants, really. The medical profession is now chock full of "doctors" whose interests are other than the welfare of their patients anyway. Who's buying you lunch this week? Sending you samples? Shucks, plastic surgeons should be placed in prison, the procedures done for no real health concern. Hippocrates would slap the bulk of you silly.

Now for those of you out there with "problems" such as anxiety, stress, panic, listlessness, laziness, absent-mindedness, speedy heartrate, depression...WELCOME TO THE WORLD. You have no problem, you are facing/being/feeling what ALL of us, who feel, should feel. YOUR DOCTOR knows full well that strictly MENTAL problems (psuche:soul) cannot be solved by physical means. IT IS BIG BUSINESS to FEED your "problem". Remember, 30 years ago they were electric-shocking people.

Save your money and be glad you are physically OK. Smoke a joint. Piss on your meds.